Blue Horizon

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:25 AM. LPA met with facility Administrator Zhanna Davtian. Entrance interview conducted and the reason for the visit was explained. Beginning at 11:28 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This included the living room/dining area and the hallway. LPA observed the living room/dining area to contain adequate seating, a television, and activities for resident use. LPA observed a fire extinguisher mounted in the living room/dining area to be fully charged and purchased on 12/08/2025. LPA observed the hallway to be clean and free from any obstructions. The living room/dining area contained a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 11:47 AM and were functional at the time of the visit. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a locked under-sink cabinet which contained cleaning supplies. LPA observed a complete first aid kit. CONTINUED ON LIC 809C BEDROOMS: There are three (3) bedrooms in the facility; all are designated as dual occupancy resident rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 contained a direct exit to the outside of the facility. Auditory alarms were observed on facility exits and all were functional at the time of the visit. BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as a private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 116.6 and 119.1 degrees Fahrenheit, which is in compliance with regulation. LPA observed both resident bathrooms to contain appropriately secured under sink cabinets which contained personal grooming supplies for resident use. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the property; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. All emergency exits were observed to be free from obstructions. GARAGE: The garage for the facility is attached to the back house on the property. LPA observed the garage to contain two (2) secured cabinets which contained extra cleaning supplies and laundry supplies. LPA observed two (2) secured filing cabinets which contained facility files and resident medications. Additionally, LPA observed the garage to contain the facility’s washer and dryer, extra care supplies, extra linens, and adequate emergency food and water supplies. RECORD REVIEW: Record review began at 11:50 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 01:07 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/08/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) resident and two (2) staff members. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had no concerns with the facility. Both staff interviews were conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, the resident’s rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated emergency disaster plan, LIC 500, resident roster, and liability insurance. No deficiencies were cited during today's inspection. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual inspection. LPA arrived at the facility at 9:25AM, met with the facility Licensee Zhanna Davtian and explained the purpose of the visit. LPA Huynh and Licensee conducted a tour of the physical plant at 9:30AM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 9:40AM and were operational. The fire extinguisher was fully charged and purchased on 02/24/2025. The LPA observed required postings on hallways and night lights throughout the facility. KITCHEN: Knives are stored inaccessible in a drawer under the sink. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator were stocked with a variety of foods. Prepared foods were safely covered with lids and labeled appropriately. Report Continued on LIC 809-C GARAGE: An adequate supply of emergency food and water supply for six residents and two staff were observed in the garage, which is locked at all times. Facility files and medications are stored in the garage and are locked. BEDROOMS: The facility has three bedrooms; Room #1 is shared, Room #2 is private, and Room #3 is shared and cleared for non-ambulatory residents. Bedrooms were furnished appropriately with sufficient lighting and an extra supply of bed linens stored in the hallways. BATHROOMS: There are two bathrooms; one in Room #3 and one designated for shared resident and visitor use. Residents’ bathrooms were observed to be in clean condition with grab bars and non-skid mats available. Hand washing signs were displayed, and sufficient amounts of soap and paper products were supplied in each restroom. Hot water temperature was measured at 113.6 degrees F, which is within the required range. OUTDOOR AREA: Backyard has a shaded patio equipped with outdoor furniture in good condition for residents’ use. There is one automated driveway gate for vehicles and one entry/exit gate. RECORDS: Records review began at 10:00AM. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued on LIC 809-C MEDICATIONS: Medications review began at 11:15AM; medications are centrally stored and kept inaccessible in the garage. Two out of six residents’ medications were reviewed. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. LPA reviewed the facility’s infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually. Emergency disaster drills are conducted quarterly, with the last drill documented on 02/01/2025. One staff and one resident were interviewed during today’s visit. No complaints noted. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced to conduct an annual inspection- continuation visit. The LPA was greeted by staff. The LPA informed them of the reason for the visit. Staff contacted the Administrator on the phone and stated that they would arrive shortly thereafter. LPA Urena resumed the inspection by conducting additional physical plant inspection. RECORDS: Records review began at 10:50 a.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:30 p.m.; medications are centrally stored and locked in a cabinet in the garage/office area; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed pertinent documents to the annual inspection. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility unannounced to conduct a required annual inspection. LPA Urena arrived at the facility at 1:00 p.m., met with the facility representative Asmik Arzuyan and explained the purpose of the visit. LPA Urena and Administrator conducted a tour of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a one-story dwelling located in the front of the property. Common Areas: The common areas (living room and dining room), walls and flooring were checked for cleanliness and were observed to be in good condition. Furniture was observed to be clean, appropriate, and in good condition. Fire extinguishers were observed to be serviced within the last year. Kitchen: Knives are stored in a locked box which is stored in the kitchen cupboard. Kitchen appliances were in operable condition. The facility has enough supply of perishable and a seven-day supply of non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Prepared foods were safely covered with lids. Continues on LIC 809C... Garage Area: An adequate supply of emergency food and water supply for six residents and two staff were observed. Diapers, and Personal Protection Equipment (PPE) is adequate, and the facility is able to obtain additional supplies as needed. Bedrooms: Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. The facility has three bedrooms, which have double occupancy. Bathrooms: The residents’ bathroom was observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed, and sufficient amounts of soap and paper products in each restroom. Outdoor Space: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. This is part-one of the annual inspection. Due to time constraints, a continuation annual inspection visit will be conducted in the near future. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 26, 2024

Allegation investigated: Staff are illegally evicting residents. Residents are not treated with dignity or respect by staff or other persons. Facility door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance.

On 11/28/2023, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial visit to investigate the allegations listed above. The LPA met with the Administrator Zhanna Davtian and explained the reason for the visit. At 12:30 p.m. the LPA and the administrator conducted a brief tour of the facility to inspect doors and locks. The LPA requested and reviewed records pertaining to the investigation at 1:00 p.m. The LPA interviewed the Administrator at 1:30 p.m. and residents from 2:00 p.m. to 2:45 p.m. The LPA interviewed the Reporting Party (RP) on 11/28/2023 at 11:30 a.m. The RP stated that they called the Centralized Complaint and Information Bureau (CCIB) an hour after the they had filed the complaint and they wanted to retract it, due to everything being okay now. However, the CCIB analyst told the RP that the department cannot retract the complaint, and it would still be investigated. Continues on LIC 9099C... Unsubstantiated Page 2. Staff are illegally evicting residents. On the allegation that staff are illegally evicting residents, it is the concern of the Reporting Party (RP) that the Administrator is illegally evicting residents by not giving enough days to vacate the facility. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that a resident had received an eviction notice, but the eviction notice was withdrawn the same day, after the resident and the administrator had a discussion pertaining to the events that led to the eviction notice. The interview with the Administrator revealed that there was an incident, which violated the House Rules; consequently, the administrator gave an eviction notice, which was quickly retrieved after the incident was resolved. The LPA interviewed four (4) out five (5) residents about eviction notices. The residents’ interviews revealed that they had not received eviction notices since they were admitted to the facility. Based on the information obtained through interviews, and record review, the allegation of unlawful eviction is found to be Unsubstantiated at this time. Residents are not treated with dignity or respect by staff or other persons. On the allegation that residents are not being treated with respect; it is the RP’s concern that residents are not allowed to and are restricted within the privacy of their own bedrooms to act freely. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that the relative of one of the residents was disrespectful to another resident, and not staff to residents. The interview with the Administrator revealed that typically the residents have family visitation either in the common area (living room/dining room) or outside in the patio area. The LPA interviewed four (4) out five (5) residents about their treatment by staff. The residents’ interviews revealed that they do not feel disrespect by staff, and they are treated well. They have not felt disrespect by other people either. Based on the information obtained through interviews, the allegation of staff violating the residents’ rights, is found to be Unsubstantiated at this time. Continues on LIC 9099 C... page 3. Page 3. Facility door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance. On the allegation that the facility’s door is locked with a key prohibiting residents from entering or exiting the facility without staff assistance; it is the RP’s concern that residents are being restricted to leave the facility freely at their own will and are locked out because residents don’t have a front door key and must wait for staff to open the door for them. To investigate the allegation, the LPA conducted interviews. The interview with the RP revealed that the allegation was about the front gate and not the front door of the facility. The RP stated that the front door does not have a lock, and the fence gate is kept locked from the outside. The residents have to wait for staff to open the gate from the inside, when they return from personal outings. The interview with the Administrator revealed that gate is kept locked from the outside due to activity in the neighborhood, and safety reasons for all residents and staff. The interview with four (4) out of five (5) of residents revealed that they are not prohibited from leaving or entering the facility without staff assistance. They can come and go as they please. Based on the information obtained through interviews, the allegation of staff prohibiting residents from entering or exiting the facility without staff assistance, is found to be Unsubstantiated at this time. No deficiencies cited. Exit interview conducted. A copy of the report was issued via email.the state’s words, verbatim · CDSS document, Nov 28, 2023 · control 29-AS-20231120144802